职业病住院患者心理健康状况及影响因素分析

Analysis on psychological health status of occupational disease in-patients and its influence factors

目的了解职业病住院患者心理状况,探讨其主要影响因素。方法对本院108例职业病住院患者(诊断观察或治疗患者)采用症状自评量表(SCL-90)、医院焦虑抑郁量表(HAD)、应对方式量表及自编相关因素调查进行问卷调查和心理测评。SCL-90结果与国内常模比较,并对数据进行二分类非条件Logistic回归分析。结果职业病住院患者SCL-90总分为(184.88±63.30),9项因子分最小值为(1.76±0.72),最大为(2.32±0.87),总分和9项因子分明显高于全国常模,两者比较差异有统计学意义(P<0.01)。SCL-90总分和9项因子阳性发生主要与消极应对、病情严重程度(正相关)、收入负担评分(负相关)有统计学关联(P<0.05),人际关系因子、偏执因子与职业病认知分、单位支持评分、机构服务评分(负相关)有统计学关联(P<0.05);108例合格调查对象中HAD≥9分的对象占60.18%,共65例,其中单纯抑郁10例、单纯焦虑20例、抑郁合并焦虑35例。HAD评定的抑郁、焦虑发生也与消极应对、病情严重程度(正相关)及收入负担评分、单位支持评分、职业病防治知识分、机构服务评分(负相关)有统计学关联(P<0.05)。结论职业病住院患者心理问题较突出,主要的危险因素是消极应对方式、病情严重程度;而高收入低负担、良好的单位支持、相关机构公平公正优质高效的服务及对职业病正确认知是可能的保护因素。职业病患者的心理问题在临床诊疗和事件处置过程中应得到高度关注。

Objective The study is to investigate the psychological condition of occupational disease in-patients and identified the main influence factors. Methods Symptom check-list 90 （SCL-90） and hospital anxiety and depression（HAD） were performed on 108 occupational disease in-patients to evaluate their psychological status and employed either a coping-scale questionnaire and a self-compiled related factors survey to analyze the main influence factors of their psychological status. The results of SCL-90,compared with the domestic norm and binary classification unconditional logistic regression was employed to analyze the relation between the psychological conditions and the evaluated factors. Results The total score of SCL-90 of the subjects was （184.88±63.30）, with the minimum score （1.76±0.72） and the maxium （2.32±0.87） among the 9 factors. Both the total and the 9 factors scores were significantly higher than the domestic norm（P〈0.01） and were positively correlated with negative coping style and the severity of illness while inversely correlated to the income burden score. Among the 65 subjects （60.18%） with HAD≥9, 10 cases were diagnosed as simple depression, 20 cases were simple anxiety and the other 35 concurrently diagnosed depression and anxiety. Depression and anxiety evaluated by HAD were also correlated with negative coping and the severity of illness. In addition, interpersonal relation factor and paranoia factor of the SCL-90 and the HAD-evaluated depression and anxiety were negatively correlated with occupational disease cognition, employing organization support and institution service. Conclusions The potential risk factors for the psychological problems are negative coping style and the severity of illness while the possible protective factors lay on high income and low burden,favorable support from employers, excellent and efficient service of relevant institutions and rational cognition of occupational disease.The employing organizations,medical institutions and occupational disease related departments should pay special attention to the psychological problems of occupational disease in-patients and take effective measures to protect the patients＇ mental health.